The patients enrolled in this study were quite vulnerable in that they were relatively old (average age 62) and had heart disease or at least two or more other risk factors for heart disease.High blood pressure cure supplement, natural herbal remedy to lower & control high blood pressure. Use Alistrol everyday to help maintain healthy circulation and support cardio-vascular health.

It would be interesting to know the incidence of hypoglycemia in the intensively treated arm vs the standard group. Apart from neurologic complications like strokes hypoglycemia affects the myocardium too....

Because regular readers of your blog have read The Great Cholesterol Con by Malcolm Kendrick, the answer is a little more obvious to us than it is to them.

On the stress track:

From the ACCORD team, Dr. John Buse:

"The patients enrolled in this study were quite vulnerable in that they were relatively old (average age 62) and had heart disease or at least two or more other risk factors for heart disease. Maybe we just flogged them too hard to get their sugar levels down. The intensive group had extremely rigorous treatment, with some patients taking four shots of insulin and three pills and checking their blood-sugar levels four times a day. Perhaps this was just too many drugs at too high a dosage, and the effort required just stressed them out too much. I think our conclusion is therefore that we should not be zealots about lowering blood sugar at all costs.

It might be the drugs, or it might be the carbs all by themselves. Isn't there at least some theory that glycosylation is responsible for damage to coronary arteries? And if you're taking a lot of oral hypoglycemics and insulin, might you not feel that you can eat more carbs than someone who is taking less medication?

Back when the only choices were diet, insulin and a few oral meds, the goal was always to get patients as near normal as possible. The result? Less complications.....complications that are not only common, but expected today.

Back then (1976 diploma grad) we could predict which patients were going to do well and which were going to get complications, simply by looking at their blood sugar control. And back then, we went by glucose spilling into the urine, which means blood sugars were very high. (People tested their urine at least 4 times daily, looking for glucose and ketones. When the blood glucose level exceeds the renal threshold of 180, glucose is excreted in the urine)

To state that this study shows that diabetics should strive for higher blood sugars is ludicrous. What it really suggests, of course, is that current nutritional and/or pharmacologic therapy for type 2 diabetes may, on balance, do more harm than good. When these treatments are applied more intensively, the harm becomes more readily apparent, an interesting dose-response effect that should provoke a rethinking of the entire treatment paradigm. It's long past time to abandon the notion that the goal of treatment should be to maintain blood sugar, blood pressure, HDL, LDL, etc. within target ranges. Nonsense! Unless a specific treatment regimen has been shown to reduce mortality and morbidity, and to improve quality of life (or at least not degrade it) it should be viewed with skepticism and concern for the law of unintended consequences.

ACCORD is a good example of what can happen when treatment is aimed at lab values and risk factors rather than at the fundamental disease process itself. (I'm reminded of torcetrapib, rosiglitazone, and ezetimibe here.) Insulin resistance is a defense mechanism against excessive insulin signaling. It should come as no surprise that using polypharmacy to defeat the defense mechanism may make matters worse.

I suspect the multiple drug cocktail scenario as a cause is a good first guess. My wife, an R.N., tells me that many Type 2 diabetics need to maintain their blood sugar levels above the normal level. When drugs take their levels down to what is "normal" for healthy people, they often start suffering. At least that is how I understood her comments which comes from her experience in a hospital.

I thought of the stress idea too, but I'm wondering if it maybe it was all that insulin they were shooting up with. (Thinking back on Taubes here, of course). Can't wait to see how they explain away this one.